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4L `FOR OFFICE USE: } Permit No. �� l� i+ APPLICATION FOR SANITATION PERMIT -- -----------------=---------------------------------- ---------='--------- ------------- ------------------- --- (Complete in Duplicate) -Date Issued ------------ -- --- -------------- --------------.- This Permit Ex_ ices 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This 9pp11cation is made in compliance with County Ordinance No. 549. JOB ADDRESS_ D LOCATION.S-r ._ �� ` ------------ � Owner's s ------ Phone------------------------------------ Address Zp �'" -•• ._ Contractor's Name _. _ f{ �' " ` -- ------------------- Phone i Installation will serve: Residence 0 Apartment House E] Commercial E] Trailer Court ❑ Motel. ❑ Other ij Number of living units: _y Number of bedrooms __Number of baths __ Lot size _-�*- V --- ---- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [+Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ :. Previous Application Made:- (If yes date__--__--_".-._..__.) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [j 1E TYPE OF INSTALLATION AND"SPECIFICATIONS: ` 11 ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ► ;_Septic Tank: Distance from nearest well_________________Distance from foundation----------------- Material------------- .______-.__---___-________�' f ❑ No. of compartments--------------------------Size------------------ --------- ---Liquid depth-----------:--------------Capacity-.---- ------ 4 Disposal Field: Distance from nearest well_____ _________Distance from foundation------------------_.Distance to nearest lot line_-_-----� � " ❑ Number of iines-----------------------------------Length of each line-----------------------------.Width of french--------------.---------------------1 ' r Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ i Distance to nearest well __/*_:a._-.......Distance from foundation_/_'v___---------Distance to nearest lot line__S_-__-._____ i ❑ Number of pits------I------------}Liningmaterial __.: ..--- Size: -__ / _ Depth F (Cesspool: Distance-from nearest,welLL. ._-" -."bis+ante from foundation_______________-.___ Lining material___..-.__ .--__.-__-____-------_____.i I! ❑ Size: Diameter------�----------- - --------- = Depth -------------------._Liquid Capacity-------------------- gals. ( r. i, ijPrivy: Distance from nearest well __-------------_------------------------------_"Distance from nearest building-----------_.-.___------______-._---_..-_. ❑ Distance to nearest lot line----------------- -------------------- I I� , °Remodeling and/or repairing (describe):- - ----•------------------------------•--------=------� ------------------------------- --------------------------------------------------- i ------------------:------------------------------------------------------------_---------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- 4 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ei ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. � r(Si+ - ----------------- -------------------------- - ------------------ gned]-__ r and/or Contract .. 4sysfe By----- _ :—(Ti+lei - : :(Plot plan, showing size of lot, location n relation to wells, buildings, etc., can be placed on reverse side).` I FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- --------- ---------------------------------------- DATE_.--- -'----------------- ---------------- REVIEWEDBY---- ---------------------------------------------- - --------------------- ---------------------------------------------- DATE------------------------------------------------------ ilBUILDING PERMIT ISSUED------------------------------------ ---------------------------------------------- ------------- DATE------------------------------------------------------------ ---------------------------- Alterations ---------------------- Alterations and/or recommendations------------------------------------------ --------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- ---------------------------------------- ---------------------------------------- -------------------------------------------------------------------------- ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------ ------ --- -- -------------------------- FINAL INSPECTION BY:-_>?fy�" �A Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street �f Stockton,California Lodi, California Manteca,California Tracy,California F.P.CC. i'